Healthcare Provider Details

I. General information

NPI: 1518332550
Provider Name (Legal Business Name): JACQUELINE RUTH THOMAS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 44TH AVE
DENVER CO
80211
US

IV. Provider business mailing address

3535 W 44TH AVE
DENVER CO
80211
US

V. Phone/Fax

Practice location:
  • Phone: 303-539-9362
  • Fax:
Mailing address:
  • Phone: 785-766-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number21-00040
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number115
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: